Patient Data

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Off-ended fracture through the surgical neck of humerus. Associated joint space swelling with pseudo-subluxation and lipohaemarthrosis just superior to the glenoid fossa.

2 case questions available

Q: Apart from the obvious fracture, what other evidence is there of a substantial injury?
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A: Just above the glenoid fossa there is a fluid/fluid level. This is consistent with a lipohaemarthrosis - with fat and blood filling and pooling in the joint capsule.

Q: Why are true "lateral" projections rarely performed at the shoulder?
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A: If taken straight through, most of the image would be obscured by rib shadowing. Instead alternative views such as the Y-view are typically done which provide much better assessment of the humeral head and its position in the glenoid fossa.

Case Discussion

The "surgical neck" is a common site for humeral fractures.

Identifying a lipohaemarthrosis is less common, as this typically requires the patient to remain upright and relatively static for this to develop. It follows the same underlying principle as at the knee and with other joint fractures, with marrow fat and blood causing a fluid/fluid level.